Stress: a turning tide

Tap in the word ‘stress’ on the internet search engine Google and within 0.27 seconds up will pop 20,300,000 results, ranging from the august, such as the American Institute of Stress, through to the sites such as Stress Inc – ‘a fun game and stress quiz’ from students at Columbia University.

Rarely a day goes by now without a piece of research or survey on stress landing on the desks of occupational health practitioners or being published in the press.

It’s the same with legal rulings, with the most recent being that of Barber v Somerset County Council, which reached the House of Lords at the end of April.

That landmark ruling put the onus on employers to keep on top of what causes occupational stress and how best to tackle it, while making it clear that being unsympathetic to complaints or having autocratic leadership could count against them.

The Health and Safety Executive (HSE) estimates that more than 13 million days a year are lost to work-related stress, costing about £3.7bn a year. According to the HSE, in 2001/2, more than half a million individuals experienced stress at levels that made them ill.

Yet, for many employers stress is still an extremely nebulous concept. Stress is not a recognised medical condition, and it is certainly not new. Is stress, they argue, really increasing, or is it just better recognised?

Many remain sceptical, too, about stress employment claims, arguing they can be a gravy train for the work-shy or psychologically fragile. Others more sympathetically recognise it as a modern workplace evil – the result of poor management and working practices. For both, identifying it correctly, addressing it and preventing it in the first place all appear to be fiendishly difficult.

With the publication of the final version of the HSE’s stress management standards just two months away [November], where has the stress debate come in the past decade? And – looking at the issue from an OH perspective – where are things going?

One of the biggest changes over the past decade or so, argues Judy Cook, president of the Association of OH Nurse Practitioners, has been that the stigma associated with workplace stress – that it is a weakness or a sign of not being able to cope – has begun to disappear, even if it has not gone entirely.

There has also been a phenomenal increase in the past two to three years in the amount of guidance, protocols, advice and research on stress and stress management available to health professionals, agrees Claire Raistrick, managing director of Matrick Ergonomics and an OH nurse since 1982.

“Before, you really had to dig around for it,” she says. “We have almost felt a tide turning. People are not prepared to put up with it at work.”

The changing nature of the workplace has been a key factor in this sea-change. Once an OH practitioner might have been dealing predominantly with chemical spills on the factory floor or heavy machinery injuries. Now, musculo-skeletal disorders and stress are much more likely to be at the top of the agenda.

In fact, there is now also increasing recognition of the role of stress in musculoskeletal injuries, she adds. For instance, a study in April, by the US firm Circadian Technologies, found long working hours, a lack of control over working patterns and working too many days in a row could all lead to an increased risk of ergonomics-related injuries.

Other workplace factors include the trend towards fewer people doing more of the work and, more intensively, the UK’s long hours culture, the stress of dealing with an increasingly grid-locked transport system, more performance-driven working and looser family structures that provide less support.

“There have been thousands of studies over the past 10-15 years, and we now know what the major factors are, and most of them are being reflected in the management standards being created by the HSE,” says Cary Cooper, professor of organisational psychology and health at Lancaster University Management School.

The HSE standards, Cooper, Cook and Raistrick all agree, are likely to have a profound impact on the way employers manage stress in the workplace.

The standards, as most OH professionals should be more than aware by now, will provide a yardstick against which organisations can measure their progress in tackling work-related stress in six key areas: demands, control, change, relationships, role and support.

Employers will have to achieve specified organisation-wide satisfaction percentages, ranging from 65 to 85 per cent.

The importance of the standards lies in the fact that, in many respects, the HSE is like an ocean-going tanker – it can take a long time to turn around but, once its course is set, little will stop it. Certainly the standards have been a long time in the development.

The current, final consultation period – including sounding out commuters on their views on stress and giving out CD-Roms in London’s Liverpool Street Station – has followed an exhaustive consultation and development process that goes back to 2002. The first pilots were run in April last year.

With the HSE becoming involved in stress management, employers – and the OH professionals working within those organisations – finally have a firm, credible foundation from which to work and upon which to build.

“They are very, very robust. Whatever people think about them, the criteria is accurate,” says Cooper.

Chris Rowe, head of psycho-social issues at the HSE, has pointed out that the standards will be specifically designed to help firms implement structured, organisational changes, not just to help them tackle individual cases. Education, through both HR and OH, is set to be a key part of the process.

They will focus closely on what makes up the different components of a good organisation, good job design and good management to keep stress levels in check and so improve productivity.

“We know increasingly how stress causes ill-health directly, and what the factors are. We are increasingly finding out what the risk factors are,” argues Cooper.

There is also growing recognition of the link between stress and other diseases, such as some cancers and cardiovascular conditions.

Similarly, while there is a recognition that some working environments, such as call centres, may be notoriously pressurised, stress is not industry or sector specific, or even job or task specific.

The factory worker who has to put his hand up to go to the toilet may be more stressed than the senior project manager who is working all hours because the latter has more control over his working environment even if, apparently, he’s under more pressure.

Nevertheless, there are some particular hot-spots. Just before Christmas last year, a study for call centre firm Merchants concluded that call centres were losing millions of working days a year because of staff absence, with stress a major factor.

At the same time, the HSE called for the industry to improve its OH record, with it concluding that working as a call handler was more stressful than working in other jobs, although not all staff were affected equally or by the same factors.

Similarly, in numerous surveys, most lately the CIPD’s annual absence survey, public sector workers appear more prone to stress than their private sector counterparts, with issues of job control, demands and recognition all factors.

Overall, though, stress is largely related to how an employees’ job and working environment is structured and managed, how much control they have over it, what demands are being put on them, what sort of support they can have access to and the speed of any reaction.

You may also have to throw personal issues such as family or money into the mix, although it has to be remembered there can be an element of circularity, with workplace stress feeding into family stresses, which in turn feed back into the workplace, Cooper explains.

Despite the scepticism in some quarters, Cook suggests that, over the past decade, there has generally been much more recognition by employers that stress is a problem that needs to be addressed, with the onus very much on prevention rather than management after the event. What’s more, the need to deal with stress has focused minds on the need for better overall people management initiatives.

“The HSE standards are slowly having some impact because they are providing a slightly more measured and evidenced approach,” she says.

The big challenge going forward, predicts Raistrick, will be filtering the message and best practice out to smaller and medium businesses.

Dealing with stress has, inevitably, brought OH much more centre stage in many, particularly larger, organisations. But while many big firms are getting on top of the issue, smaller and medium-sized firms still have some way to go.

The TUC estimates just 34 per cent of small firms and 13 per cent of micro-business provide any form of OH service, despite the introduction of services such as NHS Plus.

The difficulty remains that, whatever size the business is, stress is more often than not about the deep-seated culture of an organisation as much as its working methods. “It is not enough that they are providing counselling for someone who is experiencing stress. That’s just mopping it up once the stress has happened,” Raistrick says.

Similarly, while the HSE standards may bring some much-needed clarity into play when they are formally launched in November, the next step will be to get the same clarity over the best methods of intervention, suggests Cooper.

Stress is so difficult to tackle, partly because everyone reacts differently to different stressors, meaning any intervention almost has to be bespoke to that individual.

“We need more research that shows what intervention works. The strategy for dealing with it needs to be assessed, I would say that is what will be next,” says Cooper.

Stress – a raging epidemic?

Certainly, if the statistics are to be believed, stress is an increasingly serious problem in UK workplaces. But whether, as some of the more rabid quarters of the media would have us believe, it is an epidemic raging out of control, is another matter.

The Chartered Institute of Personnel and Development’s (CIPD) authoritative absence survey published in July, for instance, reported that, while minor illnesses such as colds and flu remained the most important cause of absence, stress was a growing worry, with 52 per cent of employers reporting an increase.

It was the biggest cause of long-term absence for non-manual workers and the fourth biggest cause for manual staff, with workload, management style/relationships at work, organisational change and pressure to meet targets the main stressors. More people in the public sector took stress-related absence than in the private sector, it also reported.

But perhaps just as importantly, and certainly so from the OH perspective, most employers were taking action to tackle the problem. Employers are realising stress is a problem that can be tackled – a process that will surely only gain momentum with the arrival of the HSE standards.

Almost two-thirds said they were trying to improve work-life balance, with more than half introducing stress audits or risk assessments and 55 per cent implementing training.

Its findings echoed those of the CBI/AXA survey, which in June reported that more than three-quarters of the firms polled had arrangements, either formal or informal, to help employees suffering from stress.

Yet look elsewhere and the picture appears more grim. A snapshot of just the past few months throws up a large number of reports showing concerns about rising stress levels in the workplace.

Vocational qualifications supplier City & Guilds reported in May that almost half of UK workers it polled said they suffered from stress, while in March, a study by the University of Plymouth found job insecurity was the biggest cause of stress among university lecturers.

In April, a study by law firm Peninsula discovered employers are increasingly dismissing complaints about stress as ‘just an excuse’.

Again in March, a study by the engineering body the EEF reported that four in 10 of managers said they had experienced more long-term absence cases because of stress in the past five years.

And it’s not just other workers that are at risk. Last autumn, a study by OH Recruitment found occupational health practitioners were increasingly stressed out, with some turning to alcohol or drugs to cope with rising pressures.

Learning points for OH

HSE’s stress management standards are likely to have a profound impact on OH’s management of stress, as they will provide a firm, credible foundation to work from

– There is growing recognition of stress in the workplace, and the fact that it needs to be tackled, but also growing scepticism about stress employment claims

– While the causes of stress are now much clearer than a decade ago, clarifying how best to intervene remains the next challenge

– Small and medium-sized firms still have some way to go to catch up with their larger counterparts when it comes to addressing stress issues

– Organisational and cultural change is as much an issue for tackling workplace stress as adjusting jobs or tasks

– There is a growing recognition of a link between stress and other diseases, such as some cancers and cardio-vascular conditions

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